Provider Demographics
NPI:1952603474
Name:MOORE, LUNDRIA S (LPN)
Entity Type:Individual
Prefix:
First Name:LUNDRIA
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRUE
Other - Middle Name:CARE
Other - Last Name:HEALTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3918 W CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1944
Mailing Address - Country:US
Mailing Address - Phone:414-551-7367
Mailing Address - Fax:414-551-7368
Practice Address - Street 1:3918 W CLINTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-1944
Practice Address - Country:US
Practice Address - Phone:414-551-7367
Practice Address - Fax:414-551-7368
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305909-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse